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Bone density in heart or lung transplant recipients--a longitudinal study
T K M Wang1, S O'Sullivan, G D Gamble
1Green Lane Cardiovascular Service, Aukland City Hospital, Aukland, New Zealand. TWang@adhb.govt.nz
Insights
Osteoporosis is common in heart or lung transplant candidates and persists post-transplant. Pre-transplant bone density predicts post-transplant bone health, enabling targeted interventions for transplant recipients.
Area of Science:
- Transplantation Medicine
- Bone Metabolism
- Immunosuppression
Background:
- Osteoporosis is prevalent in heart or lung transplant (HLT) candidates.
- Bone loss and increased fracture risk are common post-transplant.
- Optimal bone health management in HLT recipients lacks consensus.
Purpose of the Study:
- To report bone health data in HLT recipients before and after transplantation.
- To make recommendations for managing bone health in HLT recipients.
Main Methods:
- Identified HLT recipients (age >20) from the New Zealand HLT Service database (2000-2011).
- Extracted demographic data, immunosuppressive regimens, bisphosphonate use, and serial bone mineral density (BMD).
Main Results:
- Pretransplant osteopenia/osteoporosis prevalence was 23% (heart) and 36% (lung).
- Post-transplant, BMD decreased at the femoral neck in the first year, stabilizing with bisphosphonate use.
- Pretransplant BMD was the major predictor of post-transplant osteopenia/osteoporosis.
Conclusions:
- A significant proportion of HLT recipients have persistent pre- and post-transplant osteopenia or osteoporosis.
- Pretransplant BMD is crucial for risk stratification and targeted intervention.
- Recommendations for bone health management in HLT recipients are provided.
Background:
Osteoporosis is prevalent among heart or lung transplant (HLT) candidates. Bone loss is common posttransplant, with an associated increase in fracture risk. There is a lack of consensus regarding optimal management of bone health in HLT recipients. We report bone health data in a cohort of HLT recipients before and after transplantation and make recommendations for management.
Methods:
Patients over the age of 20 who had a heart or lung transplant between 2000 and 2011 were identified from the New Zealand HLT Service database, and demographic data, immunosuppressive regimens, bisphosphonate use, and serial bone mineral density (BMD) data were extracted.
Results:
Pretransplant BMD was available in 52 heart and 72 lung transplant recipients; 30 and 42, respectively, also had posttransplant BMD data. Pretransplant osteopenia or osteoporosis prevalence were 23% and 8% for heart candidates and 36% and 31% for lung candidates. Posttransplant, BMD decreased significantly at the femoral neck but not at the lumbar spine in the first year, with subsequent stabilization particularly in the presence of bisphosphonate use. Pretransplant BMD was the major predictor for developing osteopenia or osteoporosis after transplantation.
Conclusion:
A significant proportion of HLT recipients have osteopenia or osteoporosis pretransplant, and this persists posttransplant. Pretransplant BMD is an important predictor of subsequent osteopenia or osteoporosis development, allowing risk stratification and targeted intervention.
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